Count Yale New Haven Health System (YNHHS) among those healthcare organizations making major health IT changes in an effort to foster more meaningful collaboration at the mobile point of care.

 

I had heard YNHHS was winding down on a 36-month rip-and-replace project, swapping out its 10-year-old-plus electronic medical record for a new EMR from Epic. When I caught up with Daniel Barchi last week, the senior vice president and CIO at YNHHS confirmed the $300 million EMR implementation is now nearing completion, having launched about a month ago in a thousand-bed hospital, with roughly 600 physicians and numerous mobile practices.

 

Alignment

The EMR switchover will deliver closer alignment among Yale New Haven’s three hospitals, the EMA, and the health system. It also will align about a thousand physicians at Yale Medical Group, an independent organization.

 

While this improved alignment is helpful from a cost control perspective, Barchi says what’s really exciting about implementing the single EMR is that it enabled his department to finally tear down all of the communication barriers across these different institutions.

 

“The EMR project was driven by our desire to better align these organizations, as well as by our knowledge that the future of healthcare is population management and the use of informatics to improve clinical care,” said Barchi.

 

Mobile

YNHHS has deployed a good amount of technology enabling physicians to access data on mobile devices, primarily through physician portals. As part of its new EMR rollout, the health system also has activated a couple physician productivity tools for tablets and mobile phones.

 

“We’re starting to recognize that interconnectedness is the key to all of this,” Barchi said. “And it’s our physicians, who are caring for patients, who most need the ability to get data anywhere.”

 

At YNHHS, tablets are commonplace. Last year, the Yale School of Medicine rolled out a new initiative through which all medical students received their textbooks on a popular consumer tablet device. Between the student body and physicians who are using it, YNHHS has over 800 tablets deployed.

 

In addition to the mobile productivity tools currently enabled for physicians to assist with reviewing results and charting, Barchi expects more tools and opportunities to emerge as medical students transition from textbooks to clinical work.

 

Collaboration

It’s all well and good that YNHHS’ EMR project improved alignment among its member and affiliated organizations while supporting the hospital’s mobility plans.

 

Better still, though, is how this important early step is promoting truer collaboration at the point of care, as physicians gain critical access to complete medical records and become more facile at sharing patient data at the mobile point of care.

 

Since the IT Dept.’s goal isn’t to add technology, but to maximize the use of existing equipment and applications, they’re currently in the process of consolidating applications and reducing the number of overall systems.

 

Among other things, doing so has enabled YNHHS’ inpatient physicians to reduce the number of passwords they need to memorize from eight-plus to fewer than three.

 

“Health IT is becoming less about IT all the time,” Barchi added. “Instead of embracing the latest technology and trying to find a home for it, we watch for needs and then work with our caregivers to determine what might best meet their needs, or follow their lead if they find a tool. That’s what makes health IT so interesting; it’s not so much the technology, but finding solutions with our clinical partners.”

 

Is your health IT department working to advance collaboration at the POC? What steps are you taking?

 

As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.

 

At HIMSS 13, Dave Diamond, chief strategist at EMC, talked about how the IT and business sides of healthcare are now more aligned than ever, and how meeting Meaningful Use advanced that relationship. Watch the above video as he explains the opportunity going forward to analyze unstructured data and use that knowledge to benefit patient care.

 

What questions do you have?

Technology is making patient care a true team sport. Care coordination and collaboration among clinicians is now more available than ever before and a key area of emphasis for the NHS moving forward.  Security must also play a big part in this technology revolution, as patient data must be private and secure.

 

To address these key health IT components, Intel is hosting two seminars in London and Manchester coming up on May 14 and May 16 that will demonstrate the outcome benefits of key enabling technologies such as big data analytics, data mining, and mobility.

 

The full-day events give you an opportunity to listen to presentations and participate in collaborative sessions with healthcare industry experts. You will also be able to:

 

• Learn how healthcare organisations are developing workflows that enable sharing of information, remove barriers to care integration and support clinical and integrated governance

• See how information yielded by big data analytics can lead to improved clinical outcomes and treatment options for patients, significant research insights, improved care coordination and enhanced patient safety

• Hear from industry leaders about ways to keep mobile clinical tools (tablets, smartphones) safe from security risks.

 

Among the featured speakers are Antony Sumara, CEO at Royal Bolton Hospitals NHS Foundation Trust, who will be on hand in London on May 14. Most recently, Mr. Sumara has been involved in supporting failing organisations throughout the country, including University Hospital of North Staffordshire, Hillingdon and Mid Staffs NHS Foundation Trust. He was sent by “Monitor” and the DH, to rescue Mid Staffs and to restore public confidence in the Trust.

 

In Manchester, Bill Ollier, a Professor of Immunogenetics at Manchester University and Director of the Centre for Integrated Genomic Medical Research, will share insights on his research into the genetic basis of common complex disorders.

 

We hope to see you at one of the sessions. Be sure to register for one or both of the events, and let us know what questions you have. More information is available here.

When security technologies are introduced together with usability improvements in healthcare solutions they have a much greater chance of being approved and winning acceptance by healthcare workers. This is in contrast to introducing security technologies into healthcare organizations without usability improvements which at best have no usability impact, and may in fact have negative usability impact.

 

In my last blog, Improving Healthcare Solution Usability with Single Sign-On, I describe how too many layers of login is one of the most cumbersome usability challenges that compels healthcare workers to do risky workarounds out of compliance with privacy and security policy. Single Sign On (SSO) solutions provide a solution that can greatly reduce the number of sets of credentials as well as the number of actual logins required by healthcare workers during their day, providing major usability benefits. When such a solution is combined with more usable forms of multi-factor authentication such as wireless proximity cards (RFID, NFC or other) it can greatly improve both security and usability. In this type of solution once the healthcare worker has logged into a device they can start up multiple apps within their session without having to re-authenticate to each app. As more healthcare apps are integrated with such a SSO solution the number of separate credentials needed for the healthcare worker can be reduced, eventually to a single set of credentials required to login to the SSO solution.

 

Many SSO solutions also enable healthcare organizations to implement policy where the first login of the day requires 2 factors, perhaps the proximity card and a password, but thereafter as long as the clinician authenticates at another point in the network with their proximity card within a configurable amount of time defined by policy, eg 2 hours, then the proximity card alone is sufficient to authenticate and no password is required. This effectively enables the clinician to move between devices throughout the day with a simple tap of their proximity card.

 

SSO may also provide patient context sharing where different healthcare apps running in the same session track the same patient automatically so a clinician that searches and finds a patient in the Electronic Health Record (EHR) system can then switch over to a Picture Archiving and Communication System (PACS) and it has already automatically found the same patient, freeing the clinician from having to search for the patient again in each application. Such patient context capability may be based on the Clinical Context Object Workgroup (CCOW) standard. Clearly another major usability benefit that also mitigates risk of a clinician accidentally looking at different patients across different apps.

 

Just as important as easy login is minimizing risk of a live session being hijacked once the authenticated healthcare worker moves away from the device with the open live session. This can be done by setting an inactivity timeout to a low number of minutes, which in practice is workable from a usability standpoint since a simple tap of the wireless proximity card gets the healthcare worker back into their session. In the future technologies such as facial recognition may also enable the device to detect when the healthcare worker moves away, closing the session automatically and further reducing the window of opportunity for session hijacking.

 

Biometrics holds promise in further freeing the healthcare worker from having a wireless proximity card. This is especially compelling in healthcare where not having to touch anything can be a significant healthcare improvement since healthcare workers need to keep sterile hands. To achieve this improvement biometrics need to be both highly reliable and resilient to spoofing. For example viable facial recognition would need to have negligibly low false accept and false reject rates, and would have to be able to detect if a face in front of a device was a picture or a real person. Several strategies are emerging for this including multiple cameras able to detect depth, and facial recognition strategies that require some motion such as blinking to ensure the subject is not a static picture. The reality in healthcare is many healthcare workers, such as doctors working in multiple healthcare organizations, need separate credentials for each organization, and in a worst case a separate proximity card for each facility. As more healthcare organizations implement biometrics this has potential to reduce the number of tokens such as proximity cards required by a given healthcare worker. Furthermore, strategic initiatives such as National Strategy for Trusted Identities in Cyberspace (NSTIC) have the potential to separate Identity Providers from Service Providers where healthcare workers have one set of credentials to authenticate with the Identity Provider and could then access multiple Service Providers such as healthcare organizations without having to be issued a separate set of credentials from each healthcare organization.

 

Another technology that holds major promise is virtualization with “follow me session” where a healthcare worker that has logged into a given device to start up a secure session, started up healthcare apps within their session, and located a given patient medical record, may then move to another device, login and get access to the same session without having to start the apps and search for that patient again. This becomes particularly compelling as the number and types of devices healthcare workers use increases and their use cases require them to move between the devices seamlessly. This capability can also be especially beneficial where healthcare workers must use many shared workstations throughout their day and switching of devices is frequent even within a given patient encounter. Along with this type of compute model one can do centralized patching and management, leading to major security, manageability and operational efficiency benefits. Where virtualized healthcare clients running on mobile devices have the ability for secure local storage of limited healthcare data, for example just records for the patients a healthcare worker will see that day, they enable healthcare workers to be productive even in areas lacking network coverage or performance, such as rural areas or patient homes. This improved availability is particularly important has healthcare becomes more decentralized.

 

What kinds of solutions that combine usability and security improvements are you seeing in your healthcare organization?

Louisiana is known for a lot of great things—think seafood and southern Hospitality—but the state is also becoming a hotbed of healthcare IT development. The nickname Silicon Bayou has been tossed around a few times to describe the great innovation going on in the region.

 

For example, the second CajunCodeFest kicks off tonight in Lafayette and will be the largest healthcare developer forum in the United States. Last year, more than 275 people attended the event, with 115 participants from 15 states and three countries. This year, teams from all over the country are expected to participate in the 27-hour coding competition that provides participants the opportunity to transform “data” into healthcare solutions. The data released will be used to create solutions that encourage patients to "Own your Own Health” to make knowledgeable and informed decisions about their healthcare.

 

Heavy hitters from the health IT world will be on hand, including Dr. Farzad Mostashari, the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services.

 

Intel is proud to be a sponsor and it should be a great event that moves healthcare information technology forward. Follow us on Twitter @IntelHealthIT as we will be live tweeting and sharing photos, and watch for a recap after the event that will hightlight the winners and innovative technology. The hashtag is #CCF2.

 

What questions do you have?

Middle East oil producers have accumulated handsome budget surpluses thanks to sustained oil prices during the last decade and governments are doing the right thing by spending these on social development. Healthcare and education are the key sectors that are benefiting from this boon and information technology is claiming a fair share of government spending.

 

Qatar has already been spending a good part of its oil wealth in education and the Kingdom of Saudi Arabia is investing heavily into healthcare services including large IT deployments which include setting up three data centres and one of the largest national PACS deployments in the world. All these initiatives are tapping on cutting edge cloud solutions which offer seamless access to patient data across the care continuum as well as securely and cost effectively storing patient data.

 

Intel and our technology partners are increasingly shifting focus to healthcare IT projects in the region. We recently held a workshop in Riyadh with Dell on mobile healthcare to learn from leading healthcare providers how they are planning to improve care coordination with technology. Hamad Medical Corporation in Qatar has just delivered a Clinical Information System (CIS) Conference in Doha to more than 1,400 clinicians which offered CME, CNE and CPD credits to participants. How is that for a change that awards our caregivers for learning effective use of technology?

 

While the region is on a fast track preparing their health workforce for improved patient care, we have been researching how the Middle East is faring with respect to mobility and care coordination vis-à-vis the developed world. We have just completed a regional survey with HIMSS Analytics and the results are fairly surprising.

 

In some aspects, the region is way ahead and in some respects catching up. Among mobile devices provided to clinicians, tablets specifically for healthcare use is expected to rise to 41 percent this year from about 24 percent, while all types of cellular phones and pagers are on decline. This does not mean clinicians won’t be using them. They will simply become Bring Your Own Devices, a big challenge for device manageability. Only 3 percent of the health workforce is expected to get a smartphone or feature phone compared to as high as 45 percent procured by the healthcare institutions before.

 

I will present the survey details at a HIMSS Middle East Regional Event in Riyadh next week, and have the honor of addressing distinguished participants from regional governments, healthcare industry and the IT sector. I would like to share one worry that keeps me awake at night. A recent report from Bank of America is forecasting that the oil price will halve within two years due to a number of factors including yet again greater use of technology. Should this occur, would the Middle East governments have the same enthusiasm to continue with the social investments in healthcare and education or start to cut back just like the developed world is doing today?

 

How do we keep the momentum going to finally reap the benefits of current investments in healthcare IT? What do you think?

 

Rick Cnossen is the Worldwide Director, Healthcare IT, at Intel Corp.

 

At HIMSS 13, Carestream Health expert Cristine Kao talked about how to get patients involved in the healthcare discussion.  The company is launching a new portal where patients can see their healthcare images in real time and correspondent with their physicians.

 

Watch the above video and let us know what questions you have about bringing patients into the health IT conversation.

jamalloy

The Future of Health IT Apps

Posted by jamalloy Apr 18, 2013

 

At HIMSS 13, Will Morris, MD, associate chief medical information officer at Cleveland Clinic, unveiled the organization's new patient care app that is a heads-up dashboard of clinical care information for physicians. This application allows clinicians to view a risk-stratified list of patients based on their health status via a live Windows* 8 interface tile. Users can then select a patient and view the updated medical record in the Windows 8 touchscreen experience.

 

In the above video, learn how the app was designed and the benefits that clinicians, and patients, will realize with its deployment on the front lines of healthcare.

 

What questions do you have?

At a certain point in the lifecycle in any business, the predominant business model gets exhausted.

 

Medicine is a case in point. The dominant U.S. business model—visit based, fee-for-service—is slowly buckling under the crushing cost burden it is imposing our society.

 

Although it will take awhile to transform this $2 trillion bloated behemoth into a system that offers better care at a lower cost, there are flurry of movements under way that are both interesting and promising. One of the most interesting and most promising is the patient centered medical home (PCMH).

 

What is it? It is a primary care practice that puts together a mix of people, process, and technology so that patients get better care and better customer service.  It also intended to help increasingly burnt-out providers step off the 30 visit a day rat-race and reconnect them to a more satisfying and less frantic patient care model.

 

At the people level, the PCMH emphasizes teams of care providers vs. strict reliance on the physician for all clinical and patient decision making. The teams consist of doctors, PAs, nurses, medical assistants—and even administrative staff. This does not mean that the receptionist is making diagnoses, but rather provides the basis for a more coordinated effort to meet patient needs both before and after the visit. A simple example: a patient is referred to a cardiologist. Did they go? Has the practice received the documentation of the visit? Physicians are not going to track this, but a team member certainly can.

 

At the process level, the PCMH require practices to think about their practices not as a visit factory organized around the availability of overworked providers, but as a patient-centric service center, where it is easy for patients to make last minute appointments and communicate with the care team as question arise.

 

A PCMH also brings an element of practice accountability to patient care: Am I managing my diabetics effectively?  Are my cardiac patients adhering to the recommended meds? This is a distinct switch from the predominant model of reactive medicine to a proactive approach. This can have a big payoff for the management of chronically ill patients that consume much of our health care dollars.

 

It is impossible to implement these people and process changes without technology. The technology centerpiece of the medical home is the electronic health record (EHR), which provides not only a repository for patient information, but can also trigger preventative reminders based on the patient’s condition, plus practical tools such as e-prescribing. The EHRs make the patient record universally available to anyone with access to a workstation—a critical requirement for team based care.

 

While EHRs are very well suited to individual record keeping, they may not be as well suited at looking at populations of patients (i.e. How many of my diabetic patients are well controlled for HgA1c?). To help answer these questions some PCMHs may use a disease registry (more technology) to track patients.  Finally, since patient engagement and easy access to providers is a core element of the patient centered medical home, many are adopting patient portals and secure messaging to provide an alternative to traditional phone and fax communication.

 

Does the PCMH work? At least one study suggests that they do. Research done by Seattle-based Group Health’s medical home pilot (published in Health Affairs in May of 2012) indicated that medical home patients (when compared to patients in traditional Group Health practices) had 29 percent fewer ER visits and 6 percent fewer hospitalizations, with a net savings of about $10 per patient per month. The data also suggest improved patient satisfaction and happier providers.

 

The downside: setting up a PCMH is hard work and expensive (team based care means more practice FTEs per patient). However, the PCMH model that is not going away and is fully aligned with the necessary shift from quantity to quality in American medicine. It is the right approach.

 

What questions do you have?

 

Bruce Kleaveland is President of Kleaveland Consulting and a sponsored health IT correspondent for Intel

It is beginning to feel to me like cancer has become as common as the common cold. Almost everyone I know—in every aspect of my life—is going through a cancer experience either directly themselves or via a friend or family member.

 

The grand challenge to end cancer has certainly brought significant improvements to treatment over the past few decades, but there is still much to learn about the underlying mechanisms that cause so many diverse kinds of cancer to emerge and how they might possibly be slowed or stopped. There is still too much painful experimentation and expensive guesswork involved in treating an individual patient based on what medicine can glean from randomized studies of large populations. Healthcare today really can't know the individual in his or her genetic and disease complexity, and thus, often fails to deliver a treatment protocol with precision or positive results.

 

From roulette to precision

As a cancer patient advocate for more than two decades, I have witnessed firsthand what the lack of precision brings us. It leads to a kind of "diagnosis and drug cocktail roulette," as one oncologist described it to me years ago, because physicians lack the tools to really understand an individual's case. Thus, the grand challenge for thousands of patients I have worked with has been to survive the experimentation, the trials, and the side effects from the treatment. We all laugh but also cringe at the all-too-common mantra: "It's not the disease you have to worry about, it's the cure!" We must give medicine the means to customize cancer care—and all care—for each and every one of us.


Given these challenges, I am excited about today’s announcement that Intel and Oregon Health & Science University (OHSU) have formed a multi-year strategic collaboration to explore this kind of individually targeted cancer therapy. We will deploy next-generation computing to help solve the data-intensive challenges that personalized medicine for cancer really requires. Very complex problems—like developing the ability to “turn off” the spread of cancer in a particular person—demand multidisciplinary teams of experts working side by side. Together, Intel’s engineers and OHSU’s biomedical experts are optimizing supercomputing clusters and software to isolate the genetic variations that contribute to the root causes of illness.

 

From weeks to hours

For more than a decade, Intel technologists and social scientists have worked with OHSU (my first clinical fieldwork for Intel was in several OHSU hospitals and clinics back in 1999!) to move toward a vision of what I call "Personal Health." Our prior work together has focused on two of the three pillars of Personal Health: care anywhere and care networking.  We have developed technologies and care models for helping to care for people—especially seniors—in their own homes through telehealth, remote patient monitoring, online coaching, intelligent prompting, and care coordination of virtual, networked teams.

 

Today's announcement continues our innovation partnership with OHSU and focuses on the third pillar of Personal Health: care customization. Scientists can now gather billions of data points on how a specific patient’s cells are malfunctioning. Genetic abnormalities that cause these tumors manifest differently in each of us. What’s more, even a healthy human body creates millions of these mutations.  So it’s an enormous scientific challenge to determine, for each individual, which mutations are relevant in creating "my" disease. But that's where medicine must go.

 

We're bringing together Intel’s strengths in developing energy-efficient, extreme-scale computing solutions with OHSU’s pioneering work in imaging an individual's complex biological information in four dimensions (three-dimensional space and time). The calculations required to advance in this field are mind-boggling. Today, it takes weeks to analyze this information for an individual, but through this collaboration, we hope to shorten the data-crunching from weeks to hours and bring the costs down to something that can be clinically viable for every patient.

 

Digging into the ‘circuitry’ of cancer

If we succeed, this would mean more tests can be performed in a given time, with hopefully quicker discoveries. Eventually, this all leads to the promise of highly precise diagnostic tests to customize care for someone going through cancer because we can now understand that person’s particular mutations in enormous detail. But our joint team plans to do research not only into the mutations but also the "circuitry" that enables malignant cells to spread. The ultimate hope here is to learn how, for a specific individual, this circuitry can be “turned off” to stop the spread of cancer cells!

 

I know well what these kinds of breakthroughs could mean for patients. I have experienced my own "roulette game" of trials and experimentation for kidney disease for almost 25 years. In fact, I write this blog about our new OHSU-Intel collaboration from a hospital bed, as I recover from a routine biopsy of my new kidney transplant to make sure that it continues to do well. One of the things that helped get me to this amazing state of normal kidney function and good health again was having my whole genome sequenced.  It, too, took weeks of computing and then months upon months of analysis to make sense of my own unique case. Today, these tools are too slow, too expensive, and too rare—I want to make sure everyone has access to the kind of customized care that I lucked into.

 

Of course, there are no guarantees in this type of grand endeavor. We cannot know now how successful such investigations will be, or how soon average patients will benefit. But we do know that it is high time time to end the dangerous roulette game of diagnoses and drug cocktails that cancer patients must endure. It is time to stop the guesswork by giving physicians the tools to deliver true care customization for an individual. It is time to end the war on cancer by ending cancer once and for all. I hope and believe that this pioneering collaboration between Intel and OHSU will make significant contributions to these ends. And that one day these kinds of efforts will help make "cancer" one of those historical diseases that future generations will have heard about but not really understand because they have never seen anyone go through it.

To provoke some thinking about what the future holds for healthcare IT professionals—as well as all of us as individuals—there’s  a new TED talk I highly recommend.

 

Intel fellow Eric Dishman, GM for healthcare at Intel, distills his difficult and confusing journey through the healthcare system – and how technology can improve such journeys for future patients. You can see the video here.

 

This talk is inspiring on at least two different levels. It’s inspiring to see how computing innovation can help solve big problems, and make our lives safer and more convenient. And it’s an inspiring story of how human compassion from a stranger saved Eric’s life, giving him the kidney that he needed.

 

In the presentation, Eric demonstrates an example of how patients will be more involved in their own care, something that he has worked on for more than a decade at Intel. He conducts a live online conversation with his nephrologist while, using a handheld device, projecting a live ultrasound image of his newly transplanted kidney for the audience.

 

The talk weaves together three themes of “personal health” aided by new technology and emerging models of care:

 

Care anywhere – the infusion of mobile devices and communications technologies that let clinicians and patients stay on track – beyond wires and organizational walls.

 

Care networking – the shift from solo-based practice to true team-based care. He says, “We have got to go beyond this paradigm of isolated specialists doing parts care to multi-disciplinary teams doing person care.” Eric contrasts the efficient and comprehensive care he received from the kidney transplant team with the scattered and unconnected care he received for many years when no one knew precisely how to treat him.

 

“The sacred and somewhat over-romanticized doctor-patient 1-on-1 is a relic of the past. The future of healthcare is smart teams – and you better be on that team for yourself,” he says.

 

Care customization – the development of a care plan for the individual, taking into account everything from one’s needs and personal wishes to one’s unique genomic variations. He tells the audience how he is living proof that we are living at the cusp of a revolution in personalized medicine. He challenges the medical research community to “experiment on my avatar in software, not my body in suffering,” he says.

 

But he saves the best for last. You need to see how his 15-minute TED talk ties it all together at the end. It’s a tribute to people who make a difference, and an inspiring call to action.

 

What questions do you have?

Below is a guest blog from Mathew Taylor, ICT Solutions Strategist & Architect at Intel Corporation, who will be speaking at next week’s Hospital Cloud Forum in New York City.

 

We live in a mobile world, and healthcare technology is moving in that direction as well. Access to laptops, tablets, smart phones, and electronic medical devices, can play a key role in enabling better care with improved efficiency.

 

Virtual collaborative services, chronic disease management, and patient education are just three examples of how mobility shifts the healthcare delivery model towards higher quality care at lower cost.

 

The ability for health professionals to have remote access from anywhere to health data and to be able to share that data securely with patients AND other providers has great value. The latest personal mHealth app may inspire, but the ability for patients and health workers of varying skill levels to collaborate to achieve coordinated care is needed to support long-term improved outcomes, reducing office visits, admissions, and readmissions.

 

However, mobility requires you to think carefully about your target usage scenarios, like being able to view medical records and imaging data while securely sharing screens. Ensuring devices have the needed performance, security, and manageability to deliver a productive and secure user experience is critical. The 2012 Ponemon Institute survey on Patient Privacy & Data Security shows that the average organization in its study has lost $2.4 million over the last two years due to data breaches, so look for the latest encryption and anti-theft features.

 

So, as you continue to explore the best uses of mobility, educate yourself to understand what devices can best meet your needs. I encourage you to learn how to choose the right mobile point of care device, protect hand-held devices, and protect data on stolen laptops with anti-theft technology.

 

Next week on April 16, I’ll be participating in a panel discussion about mobility. If you are in the New York area, come be a part of the Hospital Cloud Forum at the Union League Club in New York City and sit in on the panel, mHealth: Balancing the Benefits and Risks.

 

What questions do you have about mobility in healthcare IT?

 

The benefits of analytics in healthcare are compelling, and big data is fueling this with increasing quantity and quality of patient data with potential to enable major improvements in evidence based medicine, ultimately enabling greatly improved quality of care.

 

Combining this with cloud computing enables healthcare to rapidly realize benefits with less initial capital investment, more of a pay-as-you-go financial approach, and much greater agility, amongst other benefits. However, privacy and security are major concerns and an impediment to many healthcare organizations realizing these benefits. Further, legal and regulatory compliance challenges abound, from national to state level regulations, and across verticals and different types of data.

 

I had the privilege of moderating and participating on a workshop panel filmed at HIMSS 2013 in New Orleans with a group of leading experts:

 

Nicole Martinez, Director of Nursing Informatics, Robert Wood Johnson University

Brian Balow, Partner, Dickinson Wright PLLC

Dr Khaled el Emam, CEO, Privacy Analytics

Kim Singletary, Director of Technical Solutions Marketing, McAfee

 

See highlights of our workshop panel at the video above.

 

We discuss frontline healthcare workers real experience with analytics, the compelling benefits, common challenges, and practical solutions encountered in implementation. We also discuss the regulatory and legal landscape, and practical strategies for compliance.

 

A multi-layered approach to security emerges in our discussion as a best practice to mitigate risk, and we discuss several key security safeguards including risk based de-identification, tokenization, encryption and various administrative security controls including policy, effective training, audit and compliance, and contracts and plans with Business Associates.

 

We also discuss results from a recent HIMSS global research survey of frontline healthcare workers, highlighting challenges with IT department responsiveness and flexibility, the usability of solutions and security, and how usability is much more than a “nice to have”, having real impacts on compliance and risk where healthcare workers are compelled to use workarounds.

 

Based on this research we pose and discuss the pertinent question: “If we are going to secure our data in the cloud, which cloud is the data in?” We discuss how this research shows that the use of workarounds by healthcare workers can drive sensitive healthcare data into “side clouds” outside of the control of the healthcare organization, where it is at increased risk of confidentiality / breach, integrity, and potential trans-border data flow issues.

 

Last but not least, we discuss how usable hardware based security solutions can enable strong and usable security that avoid compelling healthcare workers to use workarounds, thereby improve compliance and reduce risk, and ultimately help ensure sensitive healthcare data stays in clouds where it is supposed to be, within the control and effective security of the healthcare organization.

 

What kinds of benefits, risks and practical solutions are you seeing with healthcare analytics in the cloud?

The road to personalized medicine is paved with a whole series of big data challenges, as the emphasis shifts from raw sequencing performance to mapping, assembly and analytics. The need to transmit terabytes of genomic information between different sites worldwide is both essential and daunting, including:

 

Collaboration with research and clinical partners worldwide to establish statistically significant patient cohorts and leverage expertise across different institutions.

Reference Genomes used to assemble sequences, perform quality control, identify and annotate variants, and perform genome-wide association studies (GWAS).

Cloud-based Analytics to address critical shortages in bioinformatics expertise and burst capacity for HPC cluster compute.

Data Management and Resource Utilization across departments in shared research HPC cluster environments, analytics clusters, storage archives, and external partners.

Medical Genomics extends the data management considerations from research to clinical partners, CLIA labs, hospitals and clinics.

 

Most institutions still rely upon shipping physical disks due to inherent problems with commodity 1 Gigabit Ethernet (GbE) networks and TCP inefficiencies. When the goal is to reduce the analytics time from weeks to hours resulting in a meaningful clinical intervention, spending days just to transport the data is not a viable option. The transition from 1GbE to 10GbE and beyond has been unusually slow in healthcare and life sciences, likely due to an overemphasis on shared compute resources, out of context from the broader usage, system architecture, and scalability requirements.

 

Data centers in other industries have been quick to adopt 10GbE and unified networking due to impressive cost savings, performance and manageability considerations. Adopting a balanced compute model – where investments in processor capacity are matched with investments in network and storage – yields significant performance gains while reducing data center footprint, power and cooling costs. Demand for improved server density and shared resource utilization drives the need for virtualization. While I/O optimization historically has addressed jumbo packet transmissions on physical infrastructure, a more realistic test is that of regular packets, comparing physical and virtualized environments over both LAN/WAN traffic conditions. Aspera and Intel are working together to address these critical challenges to big data and personalized medicine.

 

Aspera develops high-speed data transfer technologies that provide speed, efficiency, and bandwidth control over any file size, transfer distance, network condition, and storage location (i.e., on-premise or cloud). Aspera® fasp™ Transfer Technology has no theoretical throughput limit and can only be constrained by the available network bandwidth and the hardware resources at both ends of the transfers. Complete security is built in, including secure endpoint authentication, on-the-fly data encryption, and integrity verification.

 

Intel has incorporated a number of I/O optimizations in conjunction with the Intel® Xeon® E5 processor and the Intel® 10Gb Ethernet Server Adapters:

 

Intel® 10 Gigabit Ethernet (Intel® 10GbE) replaces and consolidates older 1GbE systems, reducing power costs by 45 percent, cabling by 80 percent and infrastructure costs by 15 percent, while doubling the bandwidth.  When deployed in combination with Intel® Xeon® E5 processors, Intel 10GbE can deliver up to 3X more I/O bandwidth compared to the prior generation of Intel processors.

Intel® Data Direct I/O Technology (Intel DDIO) is a key component of Intel® Integrated I/O that increases performance by allowing Intel Ethernet controllers and server adapters to talk directly with cache and maximize throughput.

PCI-SIG* Single Root I/O Virtualization (SR-IOV) provides near-native performance by providing dedicated I/O to virtual machines and completely bypassing the software virtual switch in the hypervisor. It also improves data isolation among virtual machines and provides flexibility and mobility by facilitating live virtual machine migration.

 

Aspera® fasp™ demonstrated superior transfer performance when tested in conjunction with Intel® Xeon® E5-2600 processor and Intel® 10Gb Ethernet Server Adapter, utilizing both Intel® DDIO and SR-IOV. The real-world test scenarios transmitted regular packet sizes over both physical and virtualized environments, modeling a range of LAN/WAN traffic latency and packet loss:

 

• 300 percent throughput improvement versus a baseline system that did not contain support for Intel® DDIO and SR-IOV, showing the clear advantages of Intel’s innovative Intel® Xeon® E5 processor family.

• Similar results across both LAN and WAN transfers, confirming that Aspera® fasp™ transfer performance is independent of network latency and robust to packet loss on the network.

• Approximately the same throughput for both physical and virtualized computing environments, demonstrating the combined I/O optimizations effectively overcomes the performance penalty of virtualization.

 

International collaboration, cloud-based analytics, and data management issues with terabytes of genomic information will continue to pose challenges to life science researchers and clinicians alike, but working with I/O solutions driven by Aspera and Intel, we will get there faster.

 

Read the joint Intel-Aspera whitepaper, Big Data Technologies for Ultra-High-Speed Data Transfer in Life Sciences, for details of the I/O optimization results. Explore Aspera case studies with life science customers. Watch videos about the benefits of Intel DDIO and Intel Virtualization for Connectivity with PCI-SIG* SR-IOV.

 

How do you manage transport of your large medical genomics payloads?  What big data challenges are you working to overcome?

 

The success of healthcare IT depends on providing better care to patients. At HIMSS 2013, we gathered three doctors who are on the front lines of innovating this technology and use it daily as they interact with their patients. Joseph Kim, MD, MPH, president of MCM Education, Dr. Luis Saldana, attending emergency physician, and Dr. Dirk Stanley, chief medical information officer, all agree that the best way to provide better medical care is to create a patient-centered care system. Clinicians implementing this model must plan for mobile technology, privacy and security, and cloud computing.

 

Watch the above video for a quick look at their thoughts on the future of health IT, and see the full panel discussion here

 

Mobile technology is already penetrating healthcare. For Dr. Kim, this mobility means better patient care. "A physician used to draw what they were communicating using a pen and paper. Mobile devices allow for multimedia, which brings the doctor's ideas alive for the patient," said Dr. Kim.

 

These mobile devices will not only allow physicians to share quality information easily, physicians and patients can also capture larger amounts of data. But with the additional data, comes additional risks to privacy and security.

 

“Patients must trust that their information will be seen by only the right people at the right time,” said Dr. Stanley.  Stringent privacy and security measures must occur with the hardware, software and where the data is stored.

 

Dr. Kim predicts that encryption and will continue to advance and features on mobile devices like remote wipe features will continue to be at the forefront of security. 

 

Implementing this technology presents challenges, but creating a partnership between the physicians and IT can lead to a smoother transaction. Dr. Luis Saldana advises that technology must serve a personal reason as well as a professional reason. “These tools must be accessible for them to be successful. We follow the information flow to determine our technology strategy,” he said.

 

When both patient and doctor feel comfortable with the technologies, both have the opportunity to generate a considerable amount of data. Managing big data is on the minds of all hospital CIOs. “We ask ourselves how do we process this data? What tools do we use? How often do we collect it?” said Dr. Stanley.

 

After mobility, security measures and cloud computing have been implemented, clinicians can focus on collaboration to create a patient-centered model. “So many patients are tech-savvy. They’ll use these tools to collaborate on their own care,” said Dr. Kim.

 

“Our focus is on keeping patients out of the hospital,” said Dr. Saldana.

 

The three physicians agree that collaboration is key to good patient care. For Dr. Stanley these tools and collaboration will lead to the keystone in good patient care. “We need to move toward a one patient, one chart model to make patient-centered care a reality.”

 

What do you think?

 

See the full panel discussion with Dr. Kim, Dr. Saldana and Dr. Stanley

In a 2013 HIMSS global security survey of 674 frontline healthcare workers (Workarounds in Healthcare, a Risky Trend), too many layers of login was cited by 36 percent as a key driver compelling the use of risky workarounds, which are out of compliance with policy, to get their jobs done. An example of a workaround could be a file transfer app on a personal device used to transfer sensitive healthcare data unencrypted.

 

Single Sign-On (SSO) is a natural solution to this, reducing the total number of logins required for healthcare workers to do their job “the right way,” in compliance with policy, avoiding compelling them to resort to risky workarounds. However, as more healthcare systems are integrated behind a single sign-on solution, the risk and specifically the business impact of a compromised set of credentials increases. For this reason single-sign on is often combined with stronger multi-factor authentication.

 

A key take-away from the HIMSS survey is that usability is more than a “nice to have,” directly impacting non-compliance and risk. BYOD, social media, apps and other trends are empowering healthcare workers with more tools than ever before, and this research shows that if IT departments, solutions or security gets in the way, healthcare workers can and do use workarounds to get their job done.

 

Usability issues with multi-factor authentication, and specifically separate hardware tokens are well known. People lose them, break them, don’t like them (especially if they need multiple of them), and separate hardware tokens are often associated with increased TCO (Total Cost of Ownership) due to support and provisioning costs. Intel® Identity Protection Technology provides a strong 2-factor authentication solution without a separate hardware token, thereby avoiding the usability, support and TCO issues with separate hardware tokens.

 

The “what you have” in this case is the Intel® IPT capable mobile device that gets provisioned by the healthcare worker as a secure terminal for accessing healthcare solutions and sensitive patient information. Here’s how this works: in the event that the healthcare worker’s username/password credentials are compromised, and an impersonator tries to use these stolen or lost credentials to access the healthcare solution, the login will fail and they will be blocked since they don’t have the Intel® IPT capable mobile device that was previously provisioned by the healthcare worker as a secure terminal.

 

Combining SSO with Intel® IPT combines both the usability benefits of a reduced number of logins, as well as the usability benefits of a multi-factor solution that does not require a separate hardware token, for a stronger and more usable healthcare security solution.

 

What issues are you seeing with too many layers of login in your healthcare organization, and are you looking at single sign on solutions with multi-factor authentication?

 

Tablets were once considered companion devices in health IT. However, today’s new models, like convertibles that act as both laptop and tablet, feature extra power inside that allow clinicians to collaborate with colleagues as well as enter data into EHRs. The result? Tablets are becoming primary devices in mobile point-of-care scenarios.

 

Watch the video conversation above with Lenovo ambassador Ashley Rodrigue as she describes the impact that tablets are having on healthcare.

 

What questions do you have?

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